| Note on research and authorship Impingement syndrome is often classified into three stages (Morrison, "Non-Operative Treatment"). In all three stages the early goals are to decrease pain and inflammation and reduce the pressure on the irritated tendon and/or tissues (Morrison, "Shoulder Impingement"; Rubin). In conjunction with pharmacological management, the therapist will instruct the individuals in the use of cold treatments to the shoulder to decrease inflammation. Reduction of stress to the irritated tissue is often achieved through patient education, ergonomic adjustments and/or activity modifications aimed at reducing the offending activities. These offending activities often include repetitive movements or sustained positions where the elbow is raised above the shoulder level. Stiffness may be prevented by passive range of motion exercises conducted during supervised rehabilitation and a home exercise program.
Stage I occurs in individuals who are less than 25 years old. Treatment focuses on improving strength and stability of the muscles of the shoulder girdle. These muscles include those that attach from the upper arm to the shoulder blade, as well as those that attach from the shoulder blade to the upper back (i.e., thoracic spine) (Morrison, "Shoulder Impingement"; Rubin). These exercises will help to restore the normal glenohumeral (scapula and humerus) motion pattern and often involve resistance in the form of elastic, weights or manual resistance provided by the therapist. The individual may also perform some stretching exercises (Morrison, "Non-Operative Treatment").
Stage II occurs in individuals between 25 and 40 years of age. Strengthening exercises are performed as in stage I. However, because the joint capsule becomes stiffer with age, a greater emphasis is placed on flexibility and stretching exercises. In addition, the therapist may apply manual stretching techniques to the patient's arm, shoulder blade, and the upper portion of the thoracic spine. These techniques are aimed at improving the mobility in and around the shoulder to restore the normal glenohumeral motion pattern so the subacromial space can be maintained during movement. Some recent evidence from randomized controlled trials suggests that the addition of manual therapy to a program of strengthening and stretching is superior to patient strengthening and stretching alone (Bang).
Stage III occurs in individuals over age 40. Because these individuals are older and stiffer as mentioned in stage II, the role of patient self-stretching and manual stretching treatments is often greater. Strengthening exercises are performed as in stages I and II.
The impingement at any stage may progress to a partial or full tear of the rotator cuff tendon. In addition to undergoing supervised rehabilitation, the individual should be instructed in a home exercise program to be practiced daily, and continued independently after the completion of rehabilitation (Ludewig).
Past research does not support the benefit of ultrasound for the treatment of impingement syndrome (Philadelphia Panel). Modalities may be beneficial for palliative relief of symptoms. |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical or Occupational Therapist | | Up to 16 visits within 8 weeks | | | | | | | | Surgical | |
| Physical or Occupational Therapist | | Up to 8 visits within 4 weeks | |
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| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor